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General NPI Number Information
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NPI Number | 1275047128
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Entity Type | Organization
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Legal Business Name | ALABATA EYE CENTER LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 239 REDSTONE AVE W
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City | CRESTVIEW
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State | FL
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Zip | 32536-6465
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Country | US
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Telephone | 850-331-3937
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Fax | 850-634-6136
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Provider Business Mailing Address
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Address Line | 239 REDSTONE AVE W
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City | CRESTVIEW
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State | FL
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Zip | 32536-6465
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Country | US
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Telephone | 850-331-3937
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Fax | 850-634-6136
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. PHIL ALABATA
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Credential | DO
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Telephone | 850-331-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS9285
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | OS9285
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License Number State | FL
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